Question

My last triglyceride level was 1,330 mg/dL and my cholesterol was 330 mg/dL. As well as a statin (Lopid), my doctor told me to take folic acid and niacin, and to keep increasing the dosage. I have increased my niacin dosage to 5000 to 6000 mg per day and folic acid to 1600mcg per day with no side effects. Is this too much or should I keep increasing the doses?

Answer

Triglycerides are a standard measurement in any lipid panel. Most importantly, very high triglycerides (over 1000 mg/dL) can cause an inflammation of the pancreas known as pancreatitis. This can be dangerous, even life-threatening. Therefore, such high levels should always be lowered. At levels below 1000 mg/dl pancreatitis is not a major concern.

High triglyceride levels have also been linked to higher rates of coronary artery disease. It has been difficult to prove, however, that lowering these levels with medications improves patients' risk of not developing heart disease. Therefore, the level of aggressiveness with which physicians try to lower triglyceride levels varies considerably.

Triglycerides may be lowered by lifestyle changes and by medications. The lifestyle changes include exercise and eating a low fat diet, which includes fish high in omega-3 fatty acids. These measures should be standard in anyone with high triglycerides since they are healthy measures all around. Medications used for lowering triglycerides include niacin, fibric acid derivatives such as gemfibrazol (Lopid) and 'statin' drugs such as simvastatin (Zocor). Niacin is very effective, but it tends to be less well tolerated than the other medications. Flushing of the skin is a very common reaction. This can be minimized by slowly increasing the dosage and by taking aspirin with it. Generally, levels above 5000 mg are not recommended.

Folic acid does not lower triglycerides. There is some evidence, however, that it may lower the heart attack risk.

Links

• Disease Digest: Cholesterol, Other Lipids, and Lipoproteins